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© 2003 by the American Diabetes Association, Inc.
Pathophysiology/Complications |
Insulin Sensitivity and the Risk of Incident Hypertension
Insights from the Insulin Resistance Atherosclerosis Study
1 Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
2 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
3 Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
4 Department of Medicine, University of California at Los Angeles, Los Angeles, California
OBJECTIVE—The insulin resistance syndrome has been described as including hypertension. Previous studies have documented cross-sectional associations between insulin sensitivity (SI) and blood pressure or prevalent hypertension. Prospective data have been sparse.
RESEARCH DESIGN AND METHODS—The Insulin Resistance Atherosclerosis Study (IRAS) is a prospective study of the associations of SI with atherosclerosis and other risk factors for cardiovascular disease. We examined the association between SI, measured using the frequently sampled intravenous glucose tolerance test with minimal model analysis, and incident hypertension (defined as per the Joint National Committee), at the 5-year examination in 840 IRAS participants who were free of hypertension at the baseline examination.
RESULTS—Adjusted for age, sex, ethnicity, and smoking status, for each unit greater SI, the risk of hypertension was 10% lower (95% CI 2–19, P < 0.05).
CONCLUSIONS—These findings, from a prospective study, support the presence of a modest protective association between greater SI and lower risk of hypertension. These findings support the contention that interventions that improve SI may be beneficial with respect to the development of hypertension and cardiovascular disease. This contention should be tested in randomized clinical trials.
Abbreviations: ACEI, ACE inhibitor • ARIC, Atherosclerosis Risk in Communities • CARDIA, Coronary Artery Risk Development in (Young) Adults • FSIGT, frequently sampled intravenous glucose tolerance test • IGT, impaired glucose tolerance • IRAS, Insulin Resistance Atherosclerosis Study • MINMOD, minimal model • NGT, normal glucose tolerance • SI, insulin sensitivity
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